Transcript Caring for Children With Autism Spectrum Disorders

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Incidence of Autism Spectrum
Disorders
Jean A. Frazier, MD
Executive Director, Eunice Kennedy Shriver
Center
Robert M. and Shirley S. Siff Chair in Autism
Professor of Psychiatry and Pediatrics
UMass Medical School
Sept. 22, 2015
DSM-5 Autism Spectrum Disorder
• Criteria for ASD
– Two clinical domains (instead of the 3 in DMS-IV)
• A-Deficits in social communication and social
interaction (blends social with communication)
• B-Restricted, repetitive patterns of behavior (includes
insistence on sameness)
– Symptoms must be present in early childhood
– Symptoms must impair functioning
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Diversity in Autism Spectrum
Disorders
• Intellectual level
• Communication level
• Behavioral level
PREVALENCE
1975: 1/5000
1985: 1/2500
1995: 1/500
2000: 1/150
2004: 1/125
2006: 1/110
2008: 1/88
2010: 1/68
© N of One: Autism Research Foundation
Prevalence and Extent of the
Challenge
• Highly heritable yet etiology is elusive in 80% of
cases
• 75% of children with an ASD require treatment for
emotional, physical or behavioral problems
• One of the most challenging disorders for families
and providers
Medical Comorbidity and
Psychopathology
• Poor ability to report physical symptoms and
sources of distress
• Unusual pain tolerance
• Missed medical problems may drive surface
features that resemble psychiatric d/o
– Irritable
– Lowered threshold for baseline externalizing
behaviors
– Poor appetite and sleep
– Motor restlessness
Charlot, L., Abend, S., Ravin, P., Mastis, K., Hunt, A., & Deutsch, C. Nonpsychiatric health problems among psychiatric inpatients with Intellectual
Disabilities. Journal of Intellectual Disability Research doi:10.1111/j.13652788.2010.01294.x
Medical Conditions in Autism
• Higher rates of all medical conditions studied
including:
– Eczema
– Allergies
– Asthma
– Ear and respiratory infections
– Gastrointestinal problems
– Severe Headaches and Migraines
– Seizures (Kohane et al, 2012)
• 81% of parents of youth with ASD state their
health concerns for their child had not be
adequately investigated by professional (Treating
Autism Survey, 2009)
Mortality Rate
• Increased in ASD
• Typically Gastrointestinal, Respiratory,
Seizures
• The elevated mortality rate is related to
the comorbid medical conditions and
intellectual disability rather than to ASD
• Coordinated medical care for this
population is critical
Bilder et al, 2012 ’Excess Mortality and Causes of Death In Autism
Spectrum Disorders’
Psychiatric Comorbidities
Communication
Disorders
(Thought Disorder,
Disordered
Pragmatics)
Attention Deficit Hyperactivity
(Executive Dysfunction, Hyperactivity,
Impulsivity, Inattention)
Mood Disorders
(Mood Dysregulation,
Anxiety, Depression, Mania)
Anxiety Disorders
(Social Interaction/“Empathy”:
?Shyness/Social Phobia,
Disinterest/Schizoid,
“Hostile Intent”/Schizotypal)
Asperger’s
Autism
Obsessive Compulsive Disorder
(Restricted interests
Rigid behavior
Stereotypic behavior
Compulsions)
What Challenges Does the
Community ASD Population Have?
(Lecavalier, 2006)
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Easily Frustrated (60%)
Inattention (50%)
Hyperactivity (40%)
Temper tantrums (30%)
Irritability (20%)
Fearful/Anxious (13%)
Harming self (11%)
Destroying property (11%)
Physical fighting (5%)
Most Common Chief Complaint
on Inpatient Admission
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Aggression 28%
Self Injurious Behavior 23%
Property Destruction 17%
Tantrums 16%
Decreased Functioning 8%
Sexualized Behavior 4%
Elopement 4%
Comorbid Psychiatric Disorders in
Autistic Children
Frequency of the number of comorbid lifetime DMS-IV
psychiatric diagnoses per autistic child
Top 3: Specific Phobia (43% ), OCD (37% ), and ADHD (31%)
Leyfer O, Folstein S et al. J Autism Dev Disord (2006) 36:849-861
Comorbid Psychiatric Diagnoses Given by
Community Providers Per Parent Survey
(Rosenberg et al, 2011)
• National on line registry established in 2006
- “Interactive Autism Network”
• Parent report
• 4,343 participants between ages 5-18 years
• Allowed for the assessment of community
assigned comorbid diagnoses in ASD
(rather than research assigned)
• Examined factors associated with
comorbidity (e.g. age, gender type and
severity of ASD)
Comorbid Psychiatric Diagnoses Given by
Community Providers Per Parent Survey
(Rosenberg et al, 2011)
45
40
35
30
25
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15
10
5
0
ADHD
Anxiety
depression
bipolar
Psychosis
General Intervention Aims
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Reduce unsafe behaviors
Improve self-regulation skills
Increase positive social interactions
Increase parent/guardian
management skills
• Acquire adequate community
supports to sustain post-discharge
Treatment of Autism Spectrum
Disorders
• Multi-Modal Approach
– Behavioral
– Educational
– Pharmacological
• Target Appropriate Developmental Stage
– Early Assessment and Intervention
– Ongoing Therapy
Impact of Autism on
Family
• Increased stress for each family member
• Primary focus becomes helping the
individual with autism
• May put additional stress on:
– Marriage
– Other children
– Work
– Personal relationships
– Finances
American Academy of
Pediatric Guidelines
 Identification and Evaluation of Children With
Autism Spectrum Disorders
– Pediatrics, 2007;120:1183-1215
 Management of Children With Autism Spectrum
Disorders
– Pediatrics, 2007;120:1162-1182
 Recommendations for Evaluation and Treatment
of Common Gastrointestinal Problems in Children
With ASDs
– Pediatrics, 2010;125 Suppl 1;S19-S29
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American Academy of
Pediatrics Toolkit
• Autism: Caring for Children With Autism Spectrum
Disorders: A Resource Toolkit for Clinicians
• Contents
– CD
• Physician fact sheets
• Family handouts
• Supporting documents
– Printed materials
• Poster (CDC “Act Early” campaign)
• Brochure samples
• www.aap.org/publiced/autismtoolkit.cfm
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CANDO
Center for Autism
and
Neurodevelopmental Disorders
Phone: 774-442-2263
FAX:
774-442-2270
Email:
[email protected]